Improving working lives for doctors

This page originally appeared on Support4Doctors

What’s the best way to achieve work-life balance? Why are doctors reporting less job satisfaction? How can you combat the causes of stress? Professor Cary Cooper answers your questions.

Q: Doctors these days seem more unhappy with their working lives than ever before. Could we start by looking at some of the reasons which have been suggested for this and see what you think of them? For instance, one suggestion is that the psychological contract has changed for doctors. That’s the mutual expectations of doctors and hospitals that aren’t always in the written contract of employment, but can still be real and powerful.

A: Yes. The pay wasn’t great but what you used to get once you became a GP or consultant was a lot of control, autonomy and respect in society, and the long hours were quite important in creating a relationship with patients and mutual loyalty. It helped ensure GPs in particular were seen as part of the community.

More government money has gone into both primary care and hospitals but with strings attached. These strings and the lure of higher salaries have sometimes taken doctors away from continuity of patient care and probably led to some decisions based on what is quick to do and meets government targets rather than purely clinical factors.

Doctors like to be valued by patients, but the ways things have gone, doctors have tended to end up breaking that loyalty/commitment to individual patients and the community, and this is probably a major source of stress for them.

For example, I used to know my GPs well and they knew me. These days I often end up seeing locums. The relationship isn’t the same as it was before.

Q: So what can GPs do about this?

A: GP practices have become more of a business, but not yet the professional businesses you would get in, say, the USA. Years ago, if I went to see my GP in Los Angeles he would arrange his own blood tests, X-rays or whatever, tell me to go for lunch and then come back for the results. I know this was private practice and I’m a great believer in the NHS, but if GP practices are going to run more like businesses, they could take on board some of the better practices from business and end up with more satisfied patients and more job satisfaction for the doctors.

Q: Another suggested reason that doctors are unhappy is that they have usually been trained to work with individual patients in a professional/craft tradition. As such they find themselves relatively unprepared for the sometimes different demands of working in the larger, more complex, more ‘political’, target-driven, resource-hungry organisations that modern hospitals and GP practices have become. How accurate does this assessment seem to you?

A: Yes, this is a major problem. Sitting in meetings. Being a cog in a bigger wheel. Not being valued for your clinical expertise. These are all a turn-off for many doctors but can seem to be a consequence of the way the NHS has developed.

This may not be as big an issue for the next generation of doctors as for today’s 35 to 60 year olds. They will have come into medicine knowing a bit more about the way the modern NHS works and there may be less of a clash of expectations.

Q: Work-life balance is often cited as an issue. How do you see things developing here for doctors?

A: In principle, for junior doctors and GPs in particular, new working arrangements offer the prospect of a better work-life balance – something doctors have been saying they want to achieve for years. In practice it may not be quite that simple. For instance, GPs may have less out of hours patient contact but more paperwork. One of the downsides of the government putting more money into the NHS is that they expect greater accountability and that can end up meaning more bureaucracy.

Having said that, doctors, like other people, may sometimes be complicit in the long hours culture. There’s probably been an Americanisation of the UK – with people here (including doctors) looking to earn as much as they can to achieve an affluent lifestyle, rather than a quality of life. Some doctors may have the option of working shorter hours (e.g. by doing fewer clinics), resulting in a lower income but more time with their family and for personal interests. The recent changes in working hours and arrangements are still sufficiently new that some doctors may not have had time to appreciate the full implications.

The other side of the work-life balance is job satisfaction. If you’re not happy in your work you’re going to take that home with you at night and this won’t help.

Q: What can doctors do to increase their job satisfaction?

A: Accountability isn’t going to go away, so one thing doctors could do is find ways to concentrate on what they are good at and what they enjoy, which will usually be clinical work and patient care – and find someone else to do the things they are less good at and enjoy less. GPs are particularly well placed to do this. They can bring in proper managers to manage the practice, under their medical direction. GPs have a big advantage here in that they would be employing the managers rather than vice versa, as in the hospital system.

I’m talking about managers here, incidentally, not administrators – people who can help work out what the different people in the practice are good at and help them play to their strengths, who can look ahead as well as ensuring things run smoothly on a day to day basis, and who are genuinely concerned to help the practice deliver a better medical service to patients. There are some good managers out there who don’t want to work for the big corporates but would rather use their skills for the public good.

Q: I can see how that might work for GP practices – but what about hospitals?

A: Hospitals are very different, and there has been a history of tension between clinicians and managers brought in from outside. If we had more clinicians trained to be managers who are able and willing to take on roles like chief executive and head of HR, they should have much more empathy for and understanding of the clinical side of running a hospital.

We ask a lot from doctors these days – to be good clinicians, to keep up to date in their field, to be good people managers, to operate in a more business style environment, to meet government targets and to find time for a private life. So we need to think about how we can help doctors prepare to manage all this.

Q: Are there parallels elsewhere in the world of work, for instance in other professions?

A: Engineers used to be trained just to be engineers, which was fine until they found themselves moving into management positions part way through their careers. Now the top universities offer four year degree courses for engineering, with management included from the start.

If you’re a successful doctor, whether in a hospital or a GP practice, you’re going to find yourself managing people and resources, deciding priorities, making a business case for projects and so on. Traditional doctors may say that’s not what they came into medicine, for but this kind of responsibility is a part of the job, so it makes sense to prepare doctors for it.

Q: I know you’ve suggested a three pronged strategy for stress management – to reduce the causes of stress, manage the symptoms of stress and provide ‘rehab’ support for those suffering from it. One final question then – what can we do to reduce the causes of stress?

A: A few years ago I developed a stress audit, which I piloted in a hospital, a PCT and a number of other organisations, with a representative cross section of staff. It was an online diagnostic tool, looking at all the issues known to cause stress. The findings were then used to discuss and work out solutions. The tool is called ASSET and you can find out more about it on robertsoncooper.com if you’re interested in using it yourselves.

People were able to use this to work out the causes of stress for them in their particular organisations. For instance, was it lack of clarity in people’s roles, the way people were managed, a bullying colleague, hours of work, the impact on their home life, or something else? They were then able to use this to work out solutions.

It’s worth treating the organisation you work in as seriously as you would treat a patient and using the same rigour, not just managing the symptoms but finding and treating the underlying causes of the problems being encountered. For this, just as for medicine, diagnostic tools help. They can also help you break down your analysis. For instance were the causes of the problems perceived to be different for doctors compared with support staff, for men compared with women, for different grades and so on. This approach also works because it helps you see where things are OK, so that you can focus on the problem areas.

Professor Sir Cary Cooper CBE is 50th Anniversary Professor of Organizational Psychology and Health at Manchester Business School, University of Manchester.

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